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CHINA
SYNDROME
THE TRUE STORY OF
THE 21ST CENTURY’S
FIRST GREAT EPIDEMIC
KARL TARO GREENFELD
For Esmee and Lola,
may your immune systems always mount
the appropriate responses
There are only four questions you need to ask about a virus:
What is it?
What does it do?
Where does it come from?
And how do you kill it?
—GUAN YI,
Virologist, University of Hong Kong
CONTENTS
Epigraph iii
Map vi
Dramatis Personae
Prologue
xi
vii
BOOK 1:
What Is It?
November 1, 2002–January 1, 2003
1
BOOK 2:
What Does It Do?
January 3, 2003–February 17, 2003
59
BOOK 3:
Where Does It Come From?
February 21, 2003–April 3, 2003
149
BOOK 4:
How Do You Kill It?
April 8, 2003–January 1, 2004
297
Notes on Sources and Further Reading 405
Acknowledgments 427
Index 429
About the Author
Praise
Other Books by Karl Taro Greenfeld
Credits
Cover
Copyright
About the Publisher
Map
DRAMATIS
PERSONAE
Henk Bekedam Country Director, China, World Health
Organization (WHO)
Rob Breiman Epidemiologist, formerly of the United States
Centers for Disease Control and Prevention (CDC) and now
with the International Center for Diarrheal Disease Research in
Dhaka, Bangladesh
Cao Hong Chief Respiratory Specialist, Zhongshan Number
Three Hospital
Margaret Chan
Director of Health, Hong Kong
Danny Yang Chin
Hanoi index patient
Deng Zide Director of Infectious Diseases at Guangzhou
Number Three Hospital (also known as Sun Yat-sen Hospital)
Trevor Ellis Chief Veterinarian, Hong Kong Department of
Agriculture, Fisheries, and Conservation
Fang Lin
Earliest suspected SARS case in Shenzhen
Matthew Forney
Bejing Bureau Chief, Time magazine
Keiji Fukuda Chief, Epidemiology and Surveillance Section,
United States Centers for Disease Control and Prevention
Julie Gerberding
Director, U.S. CDC
Guan Yi Assistant Professor, Department of Microbiology,
University of Hong Kong, co-head of Pandemic Preparedness in
Asia; smuggled samples from China
viii ■ D R A M A T I S P E R S O N A E
David Heymann
WHO
Executive Director, Communicable Diseases,;
Hong Tao Senior Microbiologist at the Chinese Center for
Disease Control and Prevention (CDC)’s Institute of Virology
Hu Jintao Chief Secretary of the Communist Party and President
of China
Huang Wenjie Chief of Respiratory Diseases at Guangzhou
General Military Hospital
Huang Yong Time magazine correspondent in Beijing
Susan Jakes Time magazine correspondent in Beijing
Jiang Yanyong
blower
Physician at Beijing 301 Hospital and whistle-
Jiang Zemin Former Chief Secretary of the Communist Party
and former President of China
Anna Kong
Amoy Gardens resident
Thomas G. Ksiazek Senior Pathologist, U.S. CDC
Liu Jianlun Guangzhou nephrologist and Hong Kong index patient
James Maguire
Epidemiologist, U.S. CDC
Hitoshi Oshitani Regional Advisor in Communicable Infectious
Disease Surveillance and Response, Western Pacific Region,
WHO
Malik Peiris Professor of Microbiology, University of Hong
Kong, co-head of Pandemic Preparedness in Asia; led the team
that isolated the virus
Mike Ryan Geneva-based WHO epidemiologist
Alan Schnur Coordinator for the Communicable Disease
Surveillance and Response Department in China, for the WHO
Klaus Stöhr Chief of the Global Influenza Programme at the WHO
Joseph Sung Chief of Gastroenterology and Hepatology, Prince
of Wales Hospital
John Tam
Chief of Pathology, Chinese University of Hong Kong
Carlo Urbani Hanoi-based epidemiologist and parasitologist, WHO
D R A M A T I S P E R S O N A E ■ ix
Rob Webster Pioneering expert in animal influenzas, and Guan
Yi and Malik Peiris’s mentor
Wen Jiabao Premier of China
Wu Yi Vice-Premier of China and highest-ranking woman in
Chinese government
Xiao Zhenglun Deputy Director of the Guangzhou Institute of
Respiratory Diseases and the leader of the Heyuan expedition
Xu Ruiheng Deputy Head, Guangdong CDC
E. K. Yeoh
Secretary of Health, Welfare, and Food, Hong Kong
K. Y. Yuen Chairman, Department of Microbiology, University of
Hong Kong
Sherif Zaki Senior Virologist, U.S. CDC
Zhang Wenkang
Minister of Health, China
Zhong Nanshan Director, Guangzhou Institute of Respiratory
Diseases and the most famous physican in China
PROLOGUE
YOU ARE HERE BECAUSE OF YOUR ANCESTORS’ IMMUNE SYSTEMS. IF
any of them—as tree-dwellers or hunter-gatherers on the plains of
Africa, or as farmers or herders in Bronze Age villages, or during the
great epidemics of civilized history—had succumbed to any of the
many microbes that ruthlessly cull humanity, then you would not be
reading this right now. Somehow, because of better nutrition or
greater intelligence or geographic circumstance or, most likely, just
plain dumb luck, whatever ailments, diseases, and infections your
predecessors were stricken with weren’t fatal, and those forebears
successfully reproduced. The odds against that confluence of genetic
good fortune are incalculable; statistically, a German Jew probably
had a better chance of surviving the Holocaust.
But for those of us born into the antibiotic era, modern medicine
and science have made infectious disease a remote threat. It seems
like something that happens to very poor people very far away, in
tropical villages or distant third-world cities. When there is an out­
break closer to home, like Lyme disease in Connecticut or mad cow
in England, the media coverage and public reaction almost immedi­
ately verge on hysteria. We remain, on a basic, primordial level, terri­
fied of disease. It is an unconscious fear, encoded into our DNA, and
it surfaces whenever a nasty new microbe is alleged to be aloft,
adrift, or, I suppose, afoot. Yet for all our vestigial fright, the vast
majority of us have never lived through an infectious-disease out­
break. We are, of course, a historical aberration.
Those of us in the developed world today live remarkably diseasefree lives, owing primarily to modern medicine, science, and better
xii ■ P R O L O G U E
nutrition. Diseases thrive on starvation, and there are few going hun­
gry in the lands of Carrefour, Park ’n’ Shop, and Gristedes. But trace
your own family tree back a generation, two at the most, and imme­
diately the impact of disease is apparent in genealogical dead ends—
great-uncles whose first wives died in childbirth, great-aunts whose
tombstones read B.1920–D.1923. Whooping cough, measles, small­
pox, plague, tuberculosis, dysentery, and influenza killed far more on
the Atlantic, or Pacific, crossing or during covered-wagon journeys
west than did storms, Indians, and frostbite combined. The immi­
grant’s song is one of sickness. Every family’s journey is a history of
triumph over disease.
My own father had polio as a University of Michigan senior in
1948. He was hospitalized for five months and told he might never
walk again. Fortunately, he made a full recovery. But if he had never
had polio, how different would the course of his life have been? He
would have finished college on schedule, returned to New York six
months earlier, and then perhaps not have been in residence at the
McDowell Colony fifteen years later, when my mother attended on a
painting fellowship. My father was among the last generation to be
afflicted by the disease. Today, the WHO has plans to make polio the
second virus to be eradicated after smallpox. Yet for my grandpar­
ents, polio was a persistent fear. There were outbreaks every sum­
mer. Parents warned their children to stay out of the water and
sought to keep them from playing in muddy or dirty environments.
Every cough or fever was a source of tremendous anxiety, the start of
a nervous vigil for the telltale sore neck and backache that were early
symptoms of the disease. Today, this seems almost a parody of over­
protective parenting, but it was a typical rational expression of the
fear of disease.
Yet infectious disease is a capricious demon, and in my case, I
would not be alive were it not for tuberculosis. My Japanese grand­
mother was afflicted with it as a teenager in Tottori, Japan, and, stig­
matized by this disease of poverty, was deemed a bad matrimonial
match. She was forced, instead, to marry a widower, my grandfather,
whose first wife had given him two children but had died, along with
P R O L O G U E ■ xiii
the fetus, while laboring to deliver a subsequent child. Hanako
Kometani, my grandmother, proved to be much stronger than any­
one had estimated and would have three children of her own, two
boys and one daughter—my mother. But had she not been damaged
goods because of her bout with infectious disease, she would never
have married a widower. And my mother would never have been
born, and these words might never have been written.
In my own life, I’ve given hardly a thought to disease, save when
getting poked a few times and swallowing some pills before trips to
exotic places and making sure my children are fully vaccinated. The
journalistic and fictional accounts of disease outbreaks I’ve read—
ranging from Defoe’s Journal of the Plague Year to Richard Preston’s
Hot Zone—seem like archival history or terrifying science fiction.
The health matters that have concerned me and my family have had
more to do with chronic illness, my father’s clogged arteries, my own
periodic intestinal problems, my wife’s scoliosis, and, most vexing for
my family, my brother’s autism. Infectious diseases were a matter I
had given very little thought to, before accepting a position at Time
Asia, Time magazine’s regional offshoot, and moving to Hong Kong
in 2000.
T I M E A S I A S T R I V E S T O C O V E R A S I A I N A M A N N E R S O M E W H AT S I M I L A R
to that in which Time reports on the United States. It is a difficult
task, considering the diversity and breadth of Asia, the specious
notion that Asia is one market, and the fact that the magazine has a
much smaller staff than its U.S. parent publication. The circulation
of the magazine is about three hundred thousand, versus the
American edition’s four million, and most years it ekes out a slight
profit.
The magazine, earlier this decade, published a more eclectic mix
of stories than did the U.S. edition, though that eclecticism came at
the cost of some professionalism. Our editors, writers, and reporters
tended not to be the fast-trackers you find in the Time-Life Building
on Sixth Avenue in New York. If you ended up at TIME Asia, then it
xiv
■ PROLOGUE
was likely that at some point you had screwed up, either by making a
bad career choice or, say, getting arrested in Alaska with a quarterpound of cocaine. We had reporters who hadn’t finished high school,
editors who had been in and out of rehab, such as myself, and
staffers who were still wrestling with nasty substance habits.
Certainly, there were a few A-student types with an earnest interest
in Asia, who had struck out for the Far East, eager to make their
mark in journalism; most of them would eventually head back to
New York to join our mother publication or return to graduate
school. But they were outnumbered by the Asia hands gone slightly
to seed and the young ravers who found in our offices a place to
recharge and reload between binges. Very few of our staff, as I say,
arrived here on the heels of a winning streak.
After a year as deputy editor, I became the editor of the magazine in
early 2002. My office, on the thirty-seventh floor of a high-rise in
Quarry Bay, had a panoramic view of Victoria Harbor, Kowloon beyond
that, and, in the distance, the lush mountains dividing Kowloon from
the New Territories. Just past that, out of sight, was China. If I had req­
uisitioned sleeker office furniture and kept my bookshelves organized
and my desk neater, then I would have given the impression of modest
success. As it was, I suspect I had the look of a harried editor, trying to
right several off-the-rails projects at once.
We had morning meetings during which we would map out that
week’s issue and also do long-term planning. It was in one of those
meetings, in January 2003, that we first discussed the vinegar. In
China’s Guangdong province, markets in some rural cities were
reporting a run on all kinds of vinegar as local Chinese sought to boil
the liquid in the belief that the fumes would purify the air and ward
off respiratory ailments. To my discredit, the first time a staffer pro­
posed doing a story on these rumors of vinegar boiling and of some
sort of strange new disease just across the border, I turned the idea
down. Anthony Spaeth, the executive editor of the magazine, said
this could be like that bird flu from a few years ago. But as I sat in
Hong Kong and read those awkwardly written Chinese wire-service
releases, this initially struck me as one of those weird and exotic
P R O L O G U E ■ xv
Asian stories, that month’s equivalent of Japanese schoolgirls selling
their underwear or a neighborhood committee in East Java behead­
ing a suspected witch.
Those dispatches, however, would turn out to be the first media
reports about the disease that would later be known as severe acute
respiratory syndrome, or SARS. The earliest press mention anywhere
in the world of this new disease was in the Heyuan Daily, a small
forty-thousand-circulation paper in a city of two hundred thousand a
few hours northeast of Guangzhou, the capital of Guangdong. On its
front page on January 3, 2003, this Communist Party–controlled
paper published perhaps one of the least-reassuring reassurances I
have ever come across. It read, in its entirety: “There is no epidemic
in Heyuan. There is no need for people to panic. Regarding the rumor
of ongoing epidemic in the city, Health Department officials
announced at 1:30 A.M. this morning, ‘there is no epidemic in
Heyuan.’ The official pointed out that people don’t need to panic and
there is no need to buy preventive drugs.”
Apparently, the population of Heyuan did not heed the paper’s
advice, as they continued to boil vinegar and flooded pharmacies,
causing a run on antibiotics, available without prescription in China,
and on an herbal medicine called Banlangen. Also selling briskly were
black tablets remarkably similar in consistency—and flammability—
to charcoal. Burning these was still another folk remedy for respira­
tory tract infections. Yet this proved almost as fatal as any rumored
disease when several families suffocated from the thick smoke filling
poorly ventilated, squalid apartments.
Citizens were panicking in China. But there was no one in Hong
Kong who knew whether there was any real cause for alarm.
Scanning the Chinese media gave no clues as to the extent or risk of
a possible epidemic; the Chinese government, after the first week of
January, banned any reporting on the outbreak.
Still, that year promised to be, for me and my staff, rewarding and
not at all taxing. War in Iraq looked increasingly imminent, and most
of the ambitious reporters on my staff were inquiring about covering
the coming conflict by becoming embedded with American troops.
xvi ■ P R O L O G U E
Asia, it seemed, would be a sideshow for much of the next few
months. Since Afghanistan was technically on our watch—we cov­
ered everything from Japan to Iran—we had run much of that war
reporting in late 2001, deploying at different times more than a
dozen correspondents and photographers. This time, our war cover­
age would be run out of New York, and our staffers in Iraq would be
reporting to that office.
The upside to this was that while our mother publication in New
York would be swamped, we would be able to pick up most of our
stories from the U.S. edition and so could expect to take it easy for a
few months as the Iraq conflict occupied everyone’s attention. It was
unlikely, we all felt, that there would be any Asian news that could
compete with the war for pages in the magazine.
We were mistaken.
BOOK 1
What Is It?
CHAPTER 1
■ November 1, 2002
■ Sh e n zh e n , Guangdong province, China
■ 7 Infected, 0 Dead
FA N G L I N , T W E N T Y- F O U R , T O L D M E H E H A D AW A K E N E D T O T H E U S U A L
cacophony: the bleat of a truck reversing; the steady, metallic thump of
a jackhammer; the whining buzz of a steel saw; the driving in of nails;
the slapping down of bricks; the irregular thumping—like sneakers in a
dryer—of a cement mixer.
They were building—a skyscraper, a shopping mall, a factory, a new
highway, an overpass, a subway, a train station—here, there, every­
where. Up and down the coast, from Shenzhen to Fujian to Shanghai
to Tianjin, this was what you heard. Fang Lin had already become used
to it. He had no choice, because the sound had become ubiquitous, as
regular and familiar as the breath coming through his nostrils.
He had just arrived in Shenzhen, from Nanpo in Jiangxi province.
The second son of a rice-farming family, he came of age during the era
of reforms. The Cultural Revolution and the Great Helmsman were
for him curious historical relics—Mao was the guy on the money—as
relevant to Fang’s life as Genghis Khan or Terra-cotta Warriors. Even
the great events of his childhood were shrouded in the same obfuscat­
ing gauze of prehistory: Tiananmen represented in his mind nothing
more than a square in Beijing. His parents, recalling the hardship of
China’s great upheavals of the fifties and sixties, were grateful to be
allowed to farm their plot, raise their children, and pay their local offi­
cials for the right to slaughter their own chickens, ducks, and pigs. They
even owned their ancestral plot now and could sell their harvest for
4 ■ K A R L TA R O G R E E N F E L D
cash. They’d bought a color television and were saving for a mobile
phone. Having lived through decades of sacrifice and poverty, they
were thrilled to be able to eat as much pork as they wanted and to
watch pirated Hong Kong action pictures on their VCD players.
But if this first post-reform generation was happy to gaze at other
people’s better lives on their TV sets, then the second generation,
Fang Lin’s cohorts, were eager to inhabit those fancier images. As
the second son, Fang didn’t stand to inherit any of the family land.
That would all go to his older brother, who was already married to a
girl from the village with bad skin who seemed to go through a box of
Choco Pies every day. She would become fat, Fang Lin warned his
brother. But for their parents, even obesity remained a virtue. There
had been no fat people before the reforms—the whole country then
had subsisted on a starvation diet.
Li tu means, literally, to leave the land, to give up life as a cultiva­
tor for a nonfarming job. For Fang Lin, the decision to leave the land
had been an easy one. He knew other second sons and first daugh­
ters who had gone south to make money. And it was money that mat­
tered now, Fang Lin knew. Even Mao—or was it Deng?—had said,
“To get rich is glorious.” There was food in the village, but there was
no money. Money was in the south, along the coasts, in the boomtowns he saw on television. China was becoming rich, but it was
becoming rich around the edges while it stayed poor in the middle.
For millions of Chinese trapped in the hinterlands, that meant hit­
ting the road, hopping a bus, truck, or train to the coast and seeking
employment in a factory or construction crew, restaurant or brothel.
The newspapers dubbed it the Hundred Million Man March, and
one boy or girl seemed to set out from the village every day to join it,
especially in the early winter, after the harvest. Fang Lin borrowed
five hundred kwai (RMB) from his brother, packed his extra shirt in
a vinyl duffel bag that his sister-in-law’s parents had received when
they visited Nanchang with their work group five years earlier, and
walked out of town to the road that ran along the river. He thumbed
a ride with a truck, buying the driver a bowl of noodles at a gas sta­
CHINA SYNDROME ■ 5
tion, and then caught a local bus south to Nanchang. He then paid a
hundred kwai for an upper berth on a sleeper bus to Shenzhen. As
soon as he was on board, he reclined and watched the TV embedded
in the roof above the driver. But soon the bus was so thick with
smoke that Fang Lin could barely make out the CCTV newscaster.
They rode for thirty-six hours, the villages gradually giving way to
county seats and the rough farmland replaced by workshops and facto­
ries. By morning they were already in Guangzhou, rolling south along
the Guan-Shen Highway, past multi-acre factory compounds with
corrugated-roofed workshops that were bigger than Fang Lin’s whole
village, rice paddies and all. Entire mountains seemed to have been
hollowed out for gravel and cement. There were stretches where the
landscape was practically lunar, just a few stones, and hunched amid
the swirling dust were a handful of shacks made of scavenged wood and
cloth. Occasionally, a family farm would appear to be holding out
between the encroaching factories and construction sites. Its crop—
usually tropical fruit—was coated by a film of dust.
When Fang Lin looked at this, he says, he thought it was beautiful.
Amazing. Progress. Soon, there would be no more farms at all. Just fac­
tories as far as the eye could see. How many people worked on a
farm—one, maybe two? But in a factory, he could not begin to count.
At the central bus station in Shenzhen, Fang Lin found a red pay
phone beside a cigarette stand and called the number he had for two
other boys from his village, Du Chan and Huang Po, who had come
south. In his thick Jiangxi accent, he asked the woman who answered
if he could leave word for his friends. She told him he could leave a
message, but it would be delivered only if the receiving party were
willing to pay a kwai for the privilege.
“Why would anyone pay if they don’t know who it’s from?” Fang
Lin recalled asking.
“Otherwise, how do we make any money from this?” she had coun­
tered. “If it’s important, he’ll pay for the message.”
Fang Lin told her who he was and that he would be arriving
shortly. He doubted anyone would ever pick up that message. After
6 ■ K A R L TA R O G R E E N F E L D
hanging up, he bought a fresh package of cigarettes and bottle of
sweet lemon tea and showed an address to the cigarette seller, who
studied it for a moment and then told him to follow the signs for the
southern border.
Fang Lin set off on foot. He stopped every hundred meters or so
and showed his address to another pedestrian. Usually, they didn’t
understand his accent. But they could read the paper and point him in
the right direction.
He was disappointed by the buildings. He had assumed they would
be taller, grander. But these were no higher than those in Nanchang,
Jiangxi’s provincial capital. And these roads were no wider. And the
people here seemed no better dressed. The difference, he noticed, was
a matter of volume. There were more tall buildings, more wide streets,
and more pedestrians. There were more shops, he discovered, selling
more clothes, more televisions, more VCDs, and more fake fur coats.
There were more rich people. More bums. More cripples and more
whores. And there were more migrants. The reason half the people he
stopped to ask for directions could not help him was that many of them
had just arrived themselves.
By the time Fang Lin found his way to the district of Shenzhen
where his fellow villagers had supposedly bivouacked, it had already
become dark and he was thirsty and hungry, having had nothing to
drink since buying the bottle of tea at the station. The neighborhood
was already swathed in shadow, the narrow alleys and dirt lanes
obscured by smoke and steam. At one corner, he found a storefront
where a woman sat behind a counter. Beside her were five booths in
which five different men were shouting into red phones. He showed
her the slip of paper with his contacts’ names and addresses. She
nodded and told him the charge would be one kwai. After he paid,
she handed him a slip of onionskin paper on which he found the
message he had left for his friends earlier that day. At least that
meant he was in the right place.
After asking around, he was told by another migrant from Jiangxi
that Du Chan and Huang Po had gone north, to find work in a fac­
tory that made the machines that make sewing machines.
CHINA SYNDROME ■ 7
Though he didn’t know anyone in Shenzhen, Fang Lin found that
numerous other men from western Jiangxi had preceded him there,
and the familiar accents seemed comforting after his two-day jour­
ney. From a stall set up in a narrow alley, he ordered a plate of
chicken intestines, scallions, and red peppers—a Jiangxi dish—and a
bottle of beer, which he shared with two other fellows he had just
met. In turn, they offered him lodging for the night—he would just
have to pitch in ten kwai for his third of the room. And if he wanted
lighting or heat, he would have to make sure to get the change from
his dinner in one-kwai coins, for the box in the room that provided
electricity by the hour.
He slipped into his sleeping pallet on the floor and turned away
from his roommates in their bunks so that he could slide his red plastic
wallet into his pants. When he woke up, his roommates were already
gone. He noticed they had rummaged through his duffel bag and taken
his cigarettes. His wallet was safe between his legs.
F A N G L I N H A D A R R I V E D I N S H E N Z H E N D U R I N G W H AT W O U L D C O M E T O
be known as the Era of Wild Flavor. China’s economic boom had
been going strong for more than a decade, especially in the south,
and Shenzhen, as the first of China’s Special Economic Zones, or
SEZs, had become the urban embodiment of that boom as well as a
cautionary tale of the social costs of turbocharged economic develop­
ment. The city had grown from a rice-farming village of a few thou­
sand to a sprawling metropolis of seven million within twenty years.
Each of the central government’s grand plans for Shenzhen, in 1980,
1982, and 1986, had been superseded before implementation as
migrants and resettlers swamped developers’ ambitions. The area of
Shenzhen was eventually expanded to 150 square kilometers divided
into six districts straddling the border with Hong Kong. Most of
Shenzhen’s residents, as many as four million, had come to town ille­
gally, not possessing the proper permits to live in the Special
Economic Zone. They survived in a legal nether zone, tolerated by
officials, employed by local manufacturers, and exploited by land­
8 ■ K A R L TA R O G R E E N F E L D
lords, bureaucrats, and cops. The city had been designed with three
million in mind, and the infrastructure was drowning in the waves of
migrants who washed in every day. “The planners of the Special
Economic Zone,” wrote Mihai Craciun in Great Leap Forward, “are
now devoted to improvisation and disorder.” The city had no choice
but to embrace chaos as a paradigm. Thousands of new buildings
went up every year, 2,063 new miles of road were laid down, and
140,000 new homes were built. Adding to Shenzhen’s status as a city
of transients was its location as the primary entrepôt between the
mainland and Hong Kong—250,000 people a day crossed this most
secure internal border in the world.
Hong Kong, of course, is now a part of China, with its own miniconstitution, the arrangement known as “one country, two systems.”
In many ways, this has resulted in Shenzhen’s becoming Hong
Kong’s parallel universe. It has the same Cantonese energy, the “get
ahead” ethos and respect for a buck—or kwai. But thanks to loose
laws, widespread prostitution, and dirty officials, you can get any­
thing you want there: knockoff Chanel bags, pirated DVDs, ecstasy
pills, one-night stands. Even the money, the objective of so much of
this underground commerce, is suspect: local taxi drivers say that
one in every twenty bills they collect is counterfeit. The city is the
richest in China and also the youngest in the world, with an average
age of twenty-four.
At ground level, in the shopping malls and restaurants of Shenzhen,
the first impression of the boom is the sheer volume of goods and serv­
ices on sale. Chinese advertising still hawks primarily based on price;
there is very little aspirational marketing. Throughout Shenzhen, the
plastic surgeons promise cheaper eyes, lips, and breasts, rather than
better ones. And for every Dunhill or Louis Vuitton boutique, there are
a thousand no-name shops operating out of retail space let by the day
or week. Vast emporia the size of football fields, given over to every
conceivable sort of cheap plastic toy and cut-rate cookware—plush
animal zoos, narrow aluminum pan alleys—make Shenzhen sometimes
seem like a ninety-nine-cent store somehow grown up into a whole city.
There are enough crappy vinyl purses to outfit an entire Brezhnev-era
CHINA SYNDROME ■ 9
Soviet megalopolis, nail clippers for every toe in China. A hairbrush for
every strand. Everything is on sale, all the time. Suggest a price, any
price, and the vendor will meet it, beat it. Money is made on volume,
and they have to sell as much as they can today because more of every­
thing is arriving tomorrow, from factories up and down the Pearl River
Delta. You see Hong Kong families returning from the Delta with all
manner of household goods loaded onto wagons—new storm windows,
heaters, blenders, car radios, tires. There is nothing that can’t be had in
the Delta for cheaper than it can be had anywhere else.
The nickname Era of Wild Flavor perfectly evoked the social,
economic, and psychic dislocations brought on by this greatest mass
urbanization in the history of the world, which coincided with, or
perhaps catalyzed, one of the most vertiginous economic booms the
planet had ever seen. A businessman friend of mine who runs facto­
ries based on the mainland recently described the Delta as a place
“where more of everything is being made than has ever been made
anywhere at any time.” That may be hyperbole, but certainly China
in general, and the Pearl River Delta in particular, has become the
low-cost, cut-rate shop floor of the world. China’s economy had
grown through the late nineties at an average annual rate of nearly
10 percent. Entire swaths of Pearl River Delta marsh and paddy
were drained to make room for factories and container ports. The
country boasts 140 car companies, 90 truck companies, two dozen
television firms, and 30 that make vacuum cleaners. China manufac­
tures enough televisions to replace the entire global supply every two
years. Fifty percent of the world’s phones are made in China, 30 per­
cent of the world’s microwave ovens (and one would guess about 100
percent of the world’s pirated CDs and knockoff Prada bags). Twenty
percent of everything Wal-Mart sells is made in China, and 25 per­
cent of Best Buy’s merchandise comes from the Middle Kingdom.
Look around your own home: that frying pan, blender, coffeemaker,
hair dryer, sewing machine, shower curtain, doormat, flowerpot,
pencil sharpener, ballpoint pen, broom, mop, and bucket. All of
them made in China, and probably in the Pearl River Delta. China’s
demand for raw materials has driven up oil and gas prices around the
10 ■ K A R L T A R O G R E E N F E L D
world, as tankers anchored off Guangzhou, Shenzhen, and Hong
Kong have to wait weeks to offload. Steel, aluminum, ore, oil—you
name the raw material, and China has bid up the global price for it
over the last two years.
The prevailing philosophy—that business model of “more is good
and cheaper is best”—became a mantra of the Era of Wild Flavor. If
you were living in the Delta, you saw that more of everything was
being sold, more money was being made, more buildings were being
erected. The tycoons of more—the factory owners, the landlords,
the scalpel cowboys doing four dozen eye jobs a day, the real estate
brokers, the pimps, the party officials—they, too, had more money
than ever before. They spent it on mah-jongg and Audi automobiles
and karaoke girls and bottles of Hennessy in ceramic Napoleon-on­
his-rearing-steed bottles.
And they spent it on Wild Flavor, yewei, a key element of new
China’s conspicuous consumption. Southern Chinese have always
noshed more widely through the animal kingdom than virtually any
other peoples on earth. During the Era of Wild Flavor, the range,
scope, and amount of wild animal cuisine consumed would increase to
include virtually every species on land, sea, or air. Wild Flavor was sup­
posed to give you face, to bring you luck, to make you fan rong, “pros­
perous.” That expression, fan rong, had become the preferred phrase
used in the Delta to denote anything that was cool. Wild Flavor tycoons
could visit a brothel in Donguan reputed to be the world’s largest,
where one could choose from more than one thousand women on dis­
play behind a glass viewing wall. There were rumors that, for the right
price, one could order soup made from human babies, which was
believed to imbue the diner with fantastic virility. Restaurants pur­
veyed a wider range of snakes and lizards, camels and dogs, monkeys
and otters. Hunters as far away as Indonesia, Thailand, and Canada
became the front end of the supply chain as Chinese traders expressed
renewed interest in fresh and dried tiger penises from Sumatra and
brown bear bladders from Manitoba. No one knew the number of
restaurants and markets selling wild animals, but Lian Junhao, the
C H I N A S Y N D R O M E ■ 11
director of Wild Animal Protection at the Guangzhou Forestry Bureau,
the department mandated with regulating Wild Flavor restaurants,
told me that in Guangzhou alone there were currently two thousand
such restaurants. And how many were there two years ago?
“Two thousand.”
When I asked whether the roundness of those numbers indicated
that his agency hadn’t been keeping such an accurate count on new
licenses, he nodded.
“Nobody really knows how many there are.”
During the one hour that I spent in his office, he issued four
licenses for new Wild Flavor restaurants.
He also told me that his office was in charge of regulating which
species could be sold and which had been banned. Snakes, for exam­
ple, were no longer for sale in Guangzhou’s Wild Flavor markets.
A half hour later, I was standing in front of a bag of writhing cobras
at Xin Yuan Market. At this stall, there were twenty-five such burlap
sacks of snakes, and there were at least twenty stalls at the market spe­
cializing in snakes. Cobra cost 130 kwai a kilogram, king snake was
cheaper, at 80 kwai, and another type of snake—I believe it was a type
of garter snake—cost about 70 kwai per kilo. A boa constrictor, black
with red and gold stripes, was the most expensive, at 170 kwai per kilo.
At that price, the whole snake would cost a reasonable seven hundred
kwai, or ninety U.S. dollars.
I first visited these wild animal markets over ten years ago. At that
time, a market like this one would contain about thirty stalls selling a
wide variety of wild animals. During that trip, I ordered snake, tur­
tle, and wild boar, which went from the seller to the carving board to
the pot right before my eyes. We ate at a table beneath a corrugated
fiberglass roof. The atmosphere of the market was genial, with kids
chasing one another between the animal cages and women sitting on
stools and chatting as they washed vegetables. Walking among the
stalls, you could look up and see the stars.
The food had been average. The snake was bony, like eating a
chicken’s neck, and the turtle had been surprisingly fatty. The boar
12 ■ K A R L T A R O G R E E N F E L D
had been disappointingly flavorless. We washed the food down with
some green beer.
By the time I returned to these markets a decade later, the style
of dining that had been a quaint local custom had become industrial­
ized. The wild animal trade had grown, commensurate with the rest
of the economy, and those markets with a few dozen stalls had grown
into vast wholesale warehouses selling millions of animals a year. In
one cage at Xin Yuan, I counted fifty-two cats pushed in so tightly
that their intestines were spilling out from between the wire bars.
There were fifty-five such cages in this one stall. There were fiftytwo stalls down this one row of vendors. And there were six rows in
this one market. And there were seven markets on this one street.
A startlingly musky smell overwhelmed me as I walked between
the stalls. I realized it was a combination of the feces of a thousand
different animal species mingled with their panicked breaths. The
range and scope of wildlife on display was a zoological chart brought
to life. There were at least a dozen types of dogs, from Saint Bernard
to Labrador. There had to be at least as many different breeds of
house cat. There were raccoon dogs, badgers, civets, squirrels, deer,
boars, rats, guinea pigs, pangolins, muskrats, ferrets, wild sheep,
mountain goats, bobcats, mountain lions, three types of monkeys,
horses, ponies, bats, and one camel out in the parking lot. And these
were just the mammals. The avian rows sold an equally diverse
range, as did the reptile rows. Predator was sometimes stacked on
top of prey. Animals that had lost paws, presumably when they were
trapped in the wild, were kept alive via IV drips. Because wild ani­
mals were more valuable than farm-raised creatures, it was rumored
that some traders would slice off the hind paw of a civet or badger to
convince potential buyers that the animal had been trapped in the
wild.
I had a list of banned animals that the director of the Wild Animal
Protection office had given me. I asked a vendor for the rare bird
species, the monkey, the tiger.
“No problem,” I was told by a smiling man with buck teeth who
said he was from Guangxi Zhuang.
C H I N A S Y N D R O M E ■ 13
“What about the regulator?” I asked.
“No problem.” He pointed to a fellow in a gray-and-blue uniform
sitting on a white plastic chair, flicking his cigarette ashes beside a
bag of banned snakes.
“Okay, how about mountain lion?”
“No problem.”
“Brown bear?”
“No problem.”
I decided to push my luck.
“How about panda?”
He shook his head. “You must be sick.”
CHAPTER 2
■ N o ve mb e r 2 9 , 2002
■ Penfold Park, Kowloon, Hong Kong, China
■ 8 Infected, 1 Dead
H O N G K O N G ’ S P E N F O L D PA R K C O M P R I S E S E I G H T M A N I C U R E D H E C TA R E S
of acacia and palm trees, three small ponds, and kilometers of gently
curving dirt paths that wind beneath an ornamental brick moon gate
and through an elaborate hedgerow maze. On autumn and winter
mornings, uniformed schoolchildren on field trips stroll hand in
hand through the park, letting go of each other to point out the pea­
cocks roosting in their aviary or the ducks and geese splashing in the
ponds. Numerous migratory birds—great egrets, little egrets, and
gray herons—attracted by this oasis of flora and fresh water amid
Hong Kong’s urban sprawl, drop in and find the regular feedings and
tended gardens to their liking. They often end up staying a season or
two before resuming their regular flight paths and returning to their
North Korean and Siberian nesting spots.
The eleven groundskeepers who maintain the park become very
familiar with the birds. During cool winter mornings, the ducks,
geese, and swans of Lesser Pond like to take the sun on the lawn just
south of the water. On warmer mornings, the flocks and gaggles are
already in the pond when the staff arrives. The waterfowl are almost
canine in their familiarity with particular gardeners and caretakers,
honking and tooting as their favorite park workers—those who feed
them their pellets—report for duty. Occasionally, one of these birds
will fall ill. If the other animals notice before the groundskeepers can
capture and take the bird to a veterinarian, the rest of the flock will
C H I N A S Y N D R O M E ■ 15
turn on their stricken comrade and, as if too impatient to allow natu­
ral selection to take its course, peck the victim to death. The park’s
caretakers usually take little notice of these fatalities, gathering and
bagging the dead bird and tossing the carcass out with the lawn trim­
mings and fallen leaves.
When Chiwai Mo arrived at work at six-thirty on November 30, he
noticed a Canada goose listing in the gray water near the brackish
algae-lined shore of Lesser Pond. The rest of the waterfowl were con­
spicuously sunning themselves on the lawn, spreading their wings in
great, almost vulgar displays of plumage that allowed each simultane­
ously to reassert its place in the pecking order and dry the delicate
feathers on the underside of its wings. Walking along the path closer to
the pond, Mo quickly deduced that the floating bird was dead; its nor­
mally rigid and muscular neck was slack and the lightbulb-shaped head
had almost dipped into the water. Scarlet rivulets of blood had run from
the bird’s nostrils, eyes, and ears into the dark pond.
Mo continued on to the office and equipment shed, where he
slipped on a pair of thigh-high rubber wading boots. From a shelf
above bags of lawn seed and fertilizer, he pulled down thick, doubleply plastic trash bags and then slid on a pair of rubber gardening
gloves. Stepping from the shed back into the sunlight, he may have
blinked for a moment in the glare—he never wore sunglasses,
despite the long days in the sun—and headed back toward the pond.
As he approached the dead bird, the rest of the geese began honk­
ing. When he took the goose by the neck, the flesh there felt surpris­
ingly soft compared with the rigid muscularity of the neck of a living
goose. The flock’s protest rose to a crescendo until Mo dropped the
bird into a plastic sack. As soon as the bird was out of view, the geese
fell silent and went back to their preening.
Back at the shed, Mo double-bagged the carcass and secured the
bag with a plastic tie before taking it to the rear of the shed and toss­
ing it into one of the plastic Dumpsters.
One dead bird was no big deal.
Ninety-five dead birds, however, was a problem. That’s how many
ducks, geese, and herons would eventually die in the Penfold Park
16 ■ K A R L T A R O G R E E N F E L D
outbreak. There would be a Chinese goose fatality discovered that
afternoon. By the next day, December 1, grounds staff would find
four dead birds, and the day after that, they would find another four.
Head groundskeeper Chiu Tsang decided to report the curious bird
deaths to his supervisor, John P. Ridley, the manager of the Jockey
Club’s racing operations.
Penfold Park also happens to be the infield of the Hong Kong Jockey
Club’s eighty-five-thousand-seat Sha Tin racecourse. The Jockey Club,
a 107-year-old foundation with a multibillion-dollar endowment that has
built schools and museums throughout Hong Kong and maintains a
legal gambling monopoly in the territory, opened the park to the com­
munity in 1979. The track that encompasses it, however, is among the
most valuable and profitable racing venues in the world. Just three hun­
dred meters as the crow—or infected gray heron—flies from Penfold
Park, twenty-three stables hold approximately 1,100 thoroughbreds
worth 140 million dollars on the hoof.
“What took you so long?” Ridley asked his head groundskeeper
when he heard about the ten dead birds. He hung up and called
Keith Watkins, the Jockey Club’s chief veterinarian, and told him,
“We have a problem.”
Watkins had taken his post in 1992, just before an outbreak of
equine influenza infected six hundred thoroughbreds and killed one,
causing the cancellation of seven race meetings and an estimated
128 million dollars in lost turnover. When he received Ridley’s call,
he immediately went and looked out at the stables, the paddock, and
the trainers fast-walking their horses around the practice post.
Whatever was killing those birds, he feared, could infect the horses.
He scrolled through his PDA and found the number for Trevor Ellis,
fifty-five, the senior veterinary officer for Hong Kong’s Department
of Agriculture, Fisheries, and Conservation. Ellis’s first reaction was,
“Oh, shit.”
CHAPTER 3
■ November 30, 2002
■ Shenzhen, China
■ 9 Infected, 1 Dead
T H AT F I R S T M O R N I N G I N S H E N Z H E N , F A N G L I N E X P L O R E D H I S N E W
neighborhood. Ka-Ta, or the Click, had been so nicknamed by resi­
dents after the whirring electricity meters that clicked away outside
most apartments there. The Click was sixty-four eight-story buildings
laid out in a perfect grid. Owing to the peculiarities of Chinese zon­
ing laws, the Click was actually a cun, or “village,” technically still
under the jurisdiction of the farming cooperative that had been here
twenty years ago when the SEZ (Special Economic Zone) was
formed. City architects, planners, and politicians had virtually no
sway here, as opposed to the areas zoned as part of Shenzhen itself,
where such individuals ruled practically by fiat. If land is zoned as
rural land, even if, as in the Click, it is now the downtown of a mas­
sive urban center, the farmers who own the land can develop their
property however they like in order to maximize their revenue. This
has resulted in abrupt and startling neighborhood divisions through­
out the Pearl River Delta. You might be walking along a wellplanned thoroughfare with wide sidewalks and potted palms every
ten meters only to find that the way dead-ends into a sprawl of illconceived tenements.
The Click was just such an arrangement. Ten years ago, the farmers’
collective that owned the land had contracted with a real estate devel­
oper to put up these white-and-pink-tiled buildings as housing for the
rapidly expanding middle class. What no one had correctly reckoned
18 ■ K A R L T A R O G R E E N F E L D
was how enthusiastically and industriously the new tenants would set
about renovating and customizing their new neighborhood. Because of
some design quirks, the neighborhood was never likely to become a
haven for middle-class families. For example, the developers had left
just two meters of clearance between the buildings. As a result, the nar­
row, unpaved alleys saw light only at high noon every day and for the
rest of the day were swathed in white fluorescence. If you were in the
Click at noon on a sunny day, the sudden appearance of this yellowy
natural light was almost confusing.
During the damp summer months, streams trickled between the
buildings; in the winter, these areas became soggy pathways. And while
the original plan had provided for commercial space in each groundfloor corner unit, enterprising tenants had rented other ground-floor
flats and then simply punched their way through the brick walls facing
the alleys to convert their flats into prime street-front retail space.
Since urban zoning laws didn’t apply to this cun, there was little that
anyone could do to restrain such sledgehammer capitalism. Electrical
lines were jury-rigged. Once a month, ChinaGas workers arrived in
groups of ten to snip away illegally rigged cables that were bootlegging
power. Many of the apartments had been subdivided into smaller oneroom units, some without water or even windows. The interiors of the
buildings had also been similarly modified, with power lines and broad­
band cables nailed to the walls in tangled masses that occasionally emit­
ted bright showers of sparks. There were buckets of sand deposited at
every landing in case of fire, but these were so full of cigarette butts one
wondered about their efficacy at containing a blaze.
Illicit commerce thrived in these alleys. There were barber poles
skirling red, white, and blue. (The barber pole, in China, very often
denotes a house of ill repute.) The hookers in skintight Lycra pants
and tube tops would grab your arm as you walked past. If they
thought you were a foreigner, they would proffer “amore, amore,”
Italian here, for some reason, being the language of love. There were
several tiny piecework factories of three sewing machines each; the
workers slept under their machines at night. There were four fellows
who could repair your shoes and one fellow who converted old tires
C H I N A S Y N D R O M E ■ 19
into sandals. There were a half dozen key duplicators. And no fewer
than a dozen doctors in one-room practices—fifty-square-foot shop
fronts usually featuring a bench covered with newspapers, a cabinet
full of pills, maybe a diploma on the wall, and a stool on which the
M.D. sat, smoking cigarettes. The doctors all specialized in treating
venereal diseases, and a frightening few also practiced cut-rate plas­
tic surgery. But it was easy to bypass the doctors and head straight for
any of the half dozen pharmacies that did a thriving business in
aphrodisiacs and antibiotics. There were the pay-by-the-call phone
centers, the pay-by-the-hour hotels, and the pay-by-the-tablet
ecstasy dealers. You could buy one of anything in the Click: a ciga­
rette, a nail, a phone call, an injection, a piece of paper, an envelope,
a stamp, a match, a tablet, a stick of gum, a bullet, a brick, a bath, a
shave, a battery, even a feel.
Each visit to the Click would reveal new discoveries. One after­
noon, I arrived to find the neighborhood in a panic. Somehow, a bag
of snakes had been left open, and a dozen serpents had crawled out.
Children were running up and down the narrow alleys, trying to
catch the serpents before they slithered into pipes and through
cracks. The hookers were standing on top of their chairs screaming,
while the men smoked cigarettes and laughed. The kids would catch
just six of the snakes, and for the next few months, citizens of the
Click would wake up with a start as they felt the slithering muscular­
ity of a snake passing over their feet.
On another occasion, a short man in a white T-shirt offered to sell
me a gun.
I T I S N O T I N T H E N AT U R E O F T H O S E L I V I N G T H R O U G H P A R A D I G M -
shifting economic booms to become reflective. And the Era of Wild
Flavor has been a boom that is redefining how Chinese people live and
even what it means to be Chinese. Life in the new cities, among these
migrant communities, is anonymous, and the pace of change can seem
vertiginous. The tightly knit social hierarchy that binds so many
Chinese together and allows for “the harmony of heaven and earth” has
20 ■ K A R L T A R O G R E E N F E L D
been largely torn asunder. In Shenzhen, the more formal greeting nin
has been virtually abandoned; since no one knows the social status of
anyone else, every greeting is a ni. Who has time for ritual anyway,
when there is money to be made? The mantra, as I say, is “more.”
Greed goes beyond good; it is everything. And the cracks and fault lines
in the system are easily ignored in the midst of life-changing wealth
that, even if you yourself can’t quite achieve it, you know someone who
has. But the warning signs are everywhere: Why are there more doc­
tors doing breast enlargements than treating diseases? Why is a disease
that was a forgotten rural plague—schistosomiasis—now appearing in
downtown Shenzhen? Why is it that I have to step over a dozen crip­
ples to reach the Armani boutique?
“Places like Shenzhen are built on sweatshops,” says Zhou Litai,
an attorney who represents victims of industrial accidents. “Old
machinery, no training, fourteen hours a day, four hundred and fifty
yuan a month, ineffective safeguards—that’s the secret of China’s
economic miracle.” Zhou is one of the very few who raised doubts
during the Era of Wild Flavor. Two other Guangdong attorneys who
did similar work were murdered in 2000.
Places like Shenzhen become giant cracks in a system that has
become more gap than spackle. The recent arrivals try to exploit
those who have just gotten off the bus. Everyone is winging it. Many
residents don’t even know their addresses. They pay for their elec­
tricity by the hour. Their telephone, if they have one, is a mobile. If a
message is truly important, it will be text-messaged to them via their
phones. And they’ll be moving in a week or two or three—so what’s
the point of giving out an address anyway? This also makes it impos­
sible for the police to keep tabs, especially in the cuns, where even
the floor plans and roadways are as impermanent as sand castles. But
the city, in some sense, thrives on this chaos. There are certainly
risks—I was robbed in Shenzhen twice—but for the quick-witted
and flexible, there are great rewards. Prices are higher here, but so
are wages. The hookers are more expensive, but they are also pret­
tier and more ethnically diverse. You may not know where you are
going, but neither does anyone else. In between appointments one
C H I N A S Y N D R O M E ■ 21
afternoon, I decided I would go look at a few apartments, reckoning
it would perhaps be cheaper to rent a place in Shenzhen rather than
commute from Hong Kong and stay in hotels for a week at a stretch.
I walked into the office of a storefront real estate broker who was
advertising several flats, one of them in the Click. I explained to the
broker what I was looking for, and he said he had several properties
that might interest me. He borrowed a set of car keys from another
broker, and we set off in his rented Hyundai. The sky was its usual
smudged brown color; in Shenzhen, most days it looks like it’s about
to rain. Yet I remember it rarely actually raining. This afternoon was
no different. After a few minutes, I realized we were driving down
the same avenue where I’d seen the giant VDT in which a cut-rate
plastic surgeon promised a “cheaper, bigger, more womanly bust.”
“Where are we going?” I asked the broker.
He explained that he wanted to show me a small apartment in
Laohu.
“But why are we going in circles?”
He shrugged.
I asked my broker when he had arrived in Shenzhen.
“Two days ago,” he explained.
This feeling that no one knew where he was going could add up to a
sense that no one knew anything. The assumption that somewhere,
somehow, there were civic forces at work—a boardroom full of wise
elders subtly directing the hidden mechanisms and machinery of the
city—was dispelled by a few days in Shenzhen. I’ve met some of those
officials, blue-suited men with fleshy faces, thick lips, and unctuous
smiles who dine every night on their government banquet accounts,
polishing off platters of Wild Flavor. They sing karaoke with Hunanese
and Shanghainese girls in slit dresses. The men who were supposed to
be looking out for the rest of us were looking out only for themselves.
For first-time visitors to the Pearl River Delta, the pollution is
often striking. You notice it initially as itchiness in the eyes, then a
sore throat, and, finally, a sort of hacking cough that stays with you
throughout your visit. Local hospitals have observed an increase in
respiratory diseases that some doctors believe is related to a more
22 ■ K A R L T A R O G R E E N F E L D
polluted environment. Mao once famously stated that environmental
woes affected only capitalist countries. In that regard, China has now
fully qualified as a capitalist state.
Other societal ills that had previously been dismissed as ailments of
the decadent West have surged. Crime is soaring in Shenzhen, with
kidnapping rising 75 percent, assault 38 percent, and murder 35 per­
cent in 2003, according to local police officials. Even more frightening,
lenient rules allowing for greater internal travel have unleashed China’s
first waves of serial killings. Every month brings news of more killings.
In Shenzhen, at the Senxin Labor Market, migrants pay ten kwai for
admission to a vast hall packed with hundreds of brokers offering jobs
and better lives. When you walk into these vast flesh markets, you get
the feeling you are being swallowed, both by the volume of humanity
and by the crushing weight of people’s aspirations. That autumn,
eleven young women who had recently emigrated from the provinces
believed they had found work with a labor broker there named Ma
Yong, himself a recent migrant. One of Ma’s neighbors found him odd
but then observed, “So many people come and go that I didn’t pay
much mind.” Ma and a female accomplice were arrested in connection
with the disappearance of the eleven women, who police believe were
murdered. In Hebei in 2003, another man was arrested and suspected
of killing sixty-five people in four provinces. Another man in Henan
allegedly murdered seventeen boys. And all these arrests were made in
one three-week period.
Throughout China’s new boomtowns, and especially in the
migrant-worker communities populated by transients, however, crim­
inality rarely reaches such morbid extremes, but petty crime is
becoming depressingly familiar. “Society now has blind spots that
have become a haven for killers,” says Ren Jiantao, head of the
School of Government at Zhongshan University, in Guangzhou. In
the damp dark of a migrant workers’ ghetto, a killer could incubate
for a long time, undisturbed. During the Era of Wild Flavor, that
killer would turn out to be viral.
■ ■ ■
C H I N A S Y N D R O M E ■ 23
F A N G L I N H A D C U T H I S H A I R S H O R T S O T H AT H I S S C A L P S H O W E D
through. Showers cost a kwai each, and this was a way of saving on
bathing expenses. With his new crew cut and his wide forehead,
bulging brown eyes, sturdy nose, and thick lips, he appeared almost
menacing, an image belied by his stutter and diffidence. At five foot
ten, he was tall for a Chinese but merely average height for a migrant
from Jiangxi. He had settled in a building that housed mostly Jiangxi
natives, and he quickly discovered that jobs and industries were
divided up based on which province the wailai renkou, or “nonlocal
people,” hailed from. Those from Henan, for example, tended to col­
lect waste and refuse to sort through for recyclable or resellable
materials. The shoe repairmen and key duplicators tended to be
from Anhui. Migrants from Fujian or from other sections of
Guangdong tended to sell building materials or work in construction.
The Uighurs opened restaurants or set up begging networks. The
men from Zhejiang tended to become garment workers. Most of the
women migrants worked in sweatshops and lived on site, in dormito­
ries, Fang Lin was told, or they worked as hookers.
For those from Jiangxi, the easiest work was found in restaurants,
as dishwashers, busboys, and what they called “cut men”—fellows
who spent their evenings chopping up ingredients. There were new
restaurants opening daily throughout Shenzhen, so demand for serv­
ice employees was steady. Within forty-eight hours, Fang Lin found
a job working for a joint managed by three brothers from Sichuan.
He called his parents after a few weeks and learned that his
grandparents had made a down payment on a burial site. It was a
south-facing plot close to the village, he was told, with very good
feng shui. His grandparents were relieved to know that they would
have a most auspicious start to their afterlife. And for Fang Lin’s
mother, this was a tremendous source of pride: she could tell her
friends that her parents would never be far from their grandchildren.
Fang Lin knew what was coming next: the cost.
The site had cost six thousand kwai, but that did not include
robes, incense, or a monk to consecrate the plot. The total would
actually be eight thousand kwai. But Fang Lin would not have to
24 ■ K A R L T A R O G R E E N F E L D
worry that his grandparents’ souls would go wandering for lack of
worldly funds, his mother told him, because they could pay in install­
ments. His grandparents had come up with 500 kwai as a down pay­
ment, which meant the family had to make monthly payments of 222
kwai for the next four years. Even the number was good luck, his
mother pointed out. As the only member of the family who earned
actual cash—instead of, say, grain or rice or coupons for grain or
rice—Fang Lin would bear that burden.
Fang Lin says he never really thought about what happens when
you die. But he knew his parents and grandparents were adamant
that one must die at home and, if possible, be buried near one’s
home and family.
“That’s good news,” he said before hanging up.
He walked along Dongmen Avenue. Already, in just the few
weeks he had been in Shenzhen, the building that had stood here
before—it had housed a nightclub featuring Russian girls, he
remembered—had been torn down and a new one was going up in
its place. Its sign promised INTERNATIONAL COMMERCE. He walked
past a Häagen-Dazs and then turned down a narrow alley, on his way
back to the Click, pausing for a moment before a Wild Flavor restau­
rant that was expanding. Living in Shenzhen, one couldn’t help but
be caught up in the frenzy and philosophy of more. Fang Lin, too,
dreamed of more. He aspired to smoke Panda cigarettes and slap
down mah-jongg tiles while he talked on his flip phone with camera
functionality. He wanted to sing karaoke with Korean girls in slit
dresses and drink ten-year-old grain liquor. Like so many in the
Delta, he dreamed of indulging in Wild Flavor, for that was the taste
of fan rong, “prosperity.” He read through the Heartiness and
Happiness menu and wondered what camel hump tasted like. He’d
had pangolin, but what about marmoset? Or badger? And what was a
turtle fish? When they wrote “monkey brains,” did they really mean
the brains of a monkey, or was that a euphemism, like the way they
wrote “phoenix” instead of “chicken”?
“Do you want a job?” a woman with gold earrings and a pearl
necklace asked him.
C H I N A S Y N D R O M E ■ 25
Fang Lin, typically, didn’t respond. The woman looked at him and
then spoke in the flat tones of a Jiangxi accent.
“Where are you from?” she asked.
He told her.
She clapped her hands together sharply, a sudden gesture that
caused Fang Lin to jump back a step.
“I have two boys from there.”
Fang Lin asked, “What’s the job?”
“Assistant driver,” she explained.
“How much?”
“Seven hundred a month.”
Fang Lin nodded.
“Come back and meet the boys.”
She led Fang Lin back through the restaurant, which the busboys
were in the process of setting up for dinner. He followed her through
the kitchen and then through a dark, fetid menagerie of caged ani­
mals—everything on the menu was here, still on the wing, claw,
hoof, or paw—out to a narrow dirt lot, where a diesel truck sat next
to a pen in which two peacocks and a boar were tied to pegs driven
into the earth. And sitting on concrete steps, drinking dense tea from
plastic mugs, were Fang Lin’s two fellow villagers Du Chan and
Huang Po.
Fang Lin smiled at his good fortune. To have found his fellow
Jiangxi friends and a new job on the same afternoon! Perhaps, despite
his having to pay for his grandparents’ burial plot, his luck was chang­
ing. The three men lit cigarettes and sat down on the steps. Du and
Huang described the job to Fang. They rode with the drivers, collected
the animals from local markets and farms, unloaded them at the restau­
rant, and then slaughtered them as the chefs called out the orders.
Every night, the restaurant went through about a dozen pangolins,
twenty badgers, two dozen civets during the winter, thirty-five or so
snakes, and a half dozen lizards. You had to move fast with the badgers
and the civets or they would take a bite out of you. In the winter, the
lizards and snakes were usually too sluggish to be a problem. But just in
case, the two young men wore thick rubber gloves.
26 ■ K A R L T A R O G R E E N F E L D
They showed Fang Lin the animal pens, the peacocks, and the boar—
very fan rong, they all agreed. Then they took him around the other
side of the truck, where there was a giant bird with feathers the size of
hundred-kwai notes.
“What is that?” Fang Lin asked.
The animal was coated in dust, and it snorted like a giant pig.
“Ostrich,” Du Chan explained.
What the boys from Jiangxi had never even considered was that
each of these creatures, destined for the banquet table, had a host of
indigenous viruses that it shed by the millions, in feces, blood, sweat,
saliva, and tears. Fang Lin and his friends would be in close proxim­
ity to microbes imported directly from the rain forests of Southeast
Asia and the wild hinterlands of China. None of the men, however,
knew what a virus was or what the risks were of a lethal microbe
jumping the species barrier.
They knew only that they were getting a sweet deal.
CHAPTER 4
■ December 10, 2002
■ Tai Lung Veterinar y Laborator y,
New Territories, Hong Kong, China
■ 20 Infected, 3 Dead
T H E R E A R E M A N Y W AY S F O R A N I M A L S T O D I E I N H O N G K O N G . D O G S
and cats are hit by cars. Pigeons and even the occasional disoriented
hawk fly into the windows of skyscrapers. Beloved domestic pets
pass away from old age. Chickens, pigs, and even snakes are slaugh­
tered in preparation for a feast. The corpses of those animals not
destined for the dining table are gathered every morning by door­
men and caretakers, and perfunctorily trashed. Yet for every hun­
dred dogs found mangled and marked by tire treads at the side of the
road, there will be one mammalian, reptilian, or avian passing that
defies explanation. Nearly every one of those suspicious animal
deaths ends up in the Tai Lung Veterinary Laboratory of the
Department of Agriculture, Fisheries, and Conservation. Animal
corpses are scooped up from Kowloon pig farms and fancy, upscale
Peak mansions, and if the fatality looks like it may be due to infec­
tious disease, the cadaver will be bagged, frozen, and driven up to
Tai Lung. There it will be slid into an airtight compartment and
passed through to the dissecting lab, where Trevor Ellis’s team will
seek to divine the cause of death. Ellis’s team performs autopsies on
about 4,000 birds, 750 fish, 200 pigs, and 250 dogs and cats every
year. The building itself is an airy, bright, plate-glass-and-concrete
structure that looks like a military bunker designed by Frank Lloyd
Wright. In addition to the necropsy lab, there are administrative
28 ■ K A R L T A R O G R E E N F E L D
offices and labs for avian virology, bacteriology, molecular biology,
and fish virus, all of which open onto a central courtyard. The staff at
Tai Lung are concerned, of course, about ailments that may afflict
the city’s population of livestock and pets, but they are perhaps even
more wary of the possibility of an avian flu outbreak. Fifty percent of
the lab’s annual budget goes to influenza.
Avian flu is the Ebola of the poultry world, a hemorrhagic fever
that induces in its victims profuse bleeding from every orifice and
can turn a chicken coop into a mass of goop and feathers in just two
days. Yet before Hong Kong experienced an avian flu outbreak in
1997, the disease had not been thought to be dangerous to humans.
That year, however, the virus jumped species (from chickens to
humans) with brutal efficiency, killing 33 percent of those it infected
and eliciting an international response that (barely) succeeded in
containing the disease to just eighteen human cases in Hong Kong.
The 1997 outbreak required the slaughtering of more than three
million chickens and ducks and the scouring of Hong Kong’s wet
markets and cost the local economy nearly a billion U.S. dollars. Still,
Ellis and other scientists felt that it had been a close-fought battle. If
the H5N1 strain of avian flu had succeeded in securing a genetic
foothold among humanity, the notoriously unstable human influenza
virus could swap genes with the avian flu virus and mutate into a
superflu that would be as contagious as human flu but with the mor­
bidity of avian flu. Humans would have no preexisting immunities to
such a superbug. The result? Imagine a strain of influenza that kills
one out of every three people infected.
Great influenza pandemics are sometimes known as slate wipers,
sharp blades of disease that scrape masses of humanity from the
earth. The influenza virus is believed to have first leaped from animals
to humans a few thousand years ago, probably in southern China,
and it has since erupted in global outbreaks every few decades or so.
The last major killer epidemic, the flu pandemic of 1918, was a
unique scourge, killing more than sixty million people—more than
the number killed in the Black Death of the sixteenth century or
during World War I. Since then, there have been smaller influenza
C H I N A S Y N D R O M E ■ 29
pandemics, in 1957 and 1968, both of which originated in southern
China. Influenza experts now say we are overdue for another great
flu pandemic. “It’s not a matter of if, but when,” says Klaus Stöhr,
head of the Global Influenza Programme at the World Health
Organization. When another pandemic emerges, it will likely also
come from southern China. Hong Kong, pressed as it is against the
guts of China, will be among the first afflicted. And because Hong
Kong is a global transportation hub—more than 240 international
flights a day originate in Chek Lap Kok airport—the virus will reach
your hometown just twenty-four hours after it reaches Hong Kong.
Such a new pandemic would first manifest itself in curious signs: a
few dead birds, perhaps, in a Hong Kong park.
Yoga instructors in Santa Monica and investment bankers in New
York have no idea of the role that a few scientists, doctors, and public
health officials in Hong Kong play in keeping them hale and hearty.
With their territory flush against influenza’s hottest zone, China’s
Guangdong province, Hong Kong’s medical and scientific commu­
nity must be ever vigilant against new influenza strains and possible
species jumpers. With twenty-four million chickens a year coming
across that border, Ag and Fish, as the Department of Agriculture,
Fisheries, and Conservation is known, is the front line in the battle to
keep avian flu out of the territory. Chinese officials deny that H5N1
is endemic to southern China, insisting that Hong Kong’s H5N1
problem is homegrown. To avoid making disease surveillance a polit­
ical issue, Ag and Fish keeps a list of two hundred poultry farms in
Guangdong that are allowed to export to Hong Kong. Those farms
employ veterinarians who screen the chicken and duck populations,
before any containers of live birds embark for Hong Kong, bleeding
birds and testing the blood for H5N1. The testing is done again at a
Hong Kong government lab near the border, where the birds are
reinspected and double-checked. Any birds found to have antibodies
for H5N1 are turned back at the border and driven to local markets
in Guangdong. China, remember, does not have an H5N1 problem.
Hong Kong’s surveillance system is expensive, absorbing 40 percent
of Ag and Fish’s entire budget, and even with the heavy monitoring,
30 ■ K A R L T A R O G R E E N F E L D
Hong Kong has on three occasions in the last six years had to slaugh­
ter millions of live birds because of H5N1 outbreaks in local livepoultry markets.
Trevor Ellis did not mention to Keith Watkins what was most
troubling about hearing of the bird deaths in Penfold Park. If the
Penfold Park birds were infected with H5N1, that would mean the
disease was afflicting migratory birds as well as poultry. Free-ranging
geese, egrets, and herons, of course, aren’t confined to pens and
coops. In 1997, it was believed that some of the human cases had
been acquired from bird droppings. If H5N1-positive migratory
birds had taken to the skies over Asia, then death was literally falling
from the sky in the form of diseased bird feces. But birds die for a lot
of reasons, Ellis well knew; there were environmental factors, botu­
lism, septosomiasis. There was no reason to jump to conclusions.
A team from Ag and Fish collected the samples from the Jockey
Club on December 4, delivering the eight bagged birds to Tai Lung in
the morning so that the packages would be in the airlock by the time
Ellis’s team arrived at 8:00 A.M. The researchers slipped into clear rub­
ber gloves, green surgical gowns, plastic eye protectors, and paper caps
and slid clear plastic protectors around their shoes before they cracked
open the first sealed door to the lab and stepped, one by one, into a
basin of blue disinfectant solution. The Tai Lung necropsy lab was
effectively a Biosafety Level (BSL) III lab, meaning, among other
safety measures, it had negative air pressure. That is, air could flow only
into the lab, keeping any stray deadly microbes from escaping it. The
lab’s air was recirculated and expelled through a filtration system that
removed any nasty microbes. To access the lab, the team had to pass
through sealed double doors. Emblazoned on the outside door was the
international biosafety symbol, the sinister seed at the center of
swirling, barbed arms, like a melting swastika. (Ebola and smallpox are
both BSL IV agents. Level IV labs require that the researchers wear
pressurized suits hooked up to air hoses. As the researchers move
through the lab, they have to detach and reattach those hoses.
Although avian flu is generally considered to be a Level III agent,
because of its pandemic potential, that categorization has become a
C H I N A S Y N D R O M E ■ 31
matter for some debate in the influenza community. Some scientists
and labs are already treating it as a Level IV agent.)
Ellis and veterinary officers Geraldine Luk and Lucy Bissett took
their places around the stainless-steel table lit from above by a large
skylight. They quickly did a visual assessment of the birds. The avian
cadavers, after they were wiped down with a disinfectant solution to
limit the distribution of feathers during dissection, were strikingly
thin and lean; the dead ducks and geese, with their wings flopping
limply and their heads dangling from flaccid necks, had completely
lost their familiar, archetypal duck and goose forms. Instead, the ani­
mals, their feathers surprisingly colorless in the morning light,
seemed like some sort of evolutionary dead end—some sort of
winged lizard that had failed to find a niche. The scientists noted that
there had been some hemorrhagic bleeding from nostrils, ears, and
mouth.
Ellis placed a goose on its back with its feet toward him and
grasped both legs, pulling them away from the pelvis to loosen the
joints. He tightened the skin over the abdomen, cut into it with a
scalpel, and removed the flap of skin covering the breast. After
examining the breast muscle for decreased mass, bruising, or pale­
ness, he cut through the ribs. The keel bone always made a satisfying
crack—like a slender branch snapping—as it was pulled upward to
expose the internal organs. Ellis noticed black patches of necrosis in
the spleen, lungs, and, later, the brain. He also found fluid leaking
from the lungs and additional discoloration and swelling in the
spleen. Slicing away all the attachments close to the GI tract and
intestines, Ellis removed the liver, kidney, and spleen and gently
teased the lungs out of the rib cage. Biopsies were taken of each dis­
eased organ.
That tissue was homogenized and centrifuged so that any
viruses—those being the lightest particles in the test tube—would
naturally stay near the top of the sample. This clear fluid was inocu­
lated into chicken embryos, which were then stored in an incubator
and candled—silhouetted against a light source—to be checked for
embryonic movement every day for three days. If the embryo died,
32 ■ K A R L T A R O G R E E N F E L D
the virology team knew they had an agent fatal to chickens. That
agent was then extracted from the embryo and tested for the pres­
ence of specific H5N1 hemagglutinins. If the avian flu hemagglu­
tinins were present, the sample would leave a pinkish color—the
same tint as a Cosmopolitan cocktail—around the bottom of the test
tube.
Ellis’s virology team soon found that whatever had killed those
ducks, geese, and herons was also relentlessly effective at wiping out
chicken embryos. When they extracted the embryonic fluid and
tested that against the hemagglutinin reagents (antibodies that react
to the presence of a microbe, essential in testing for the presence of
certain diseases), they saw that lovely, almost festive, pinkish tone
that indicated that they were in the presence of one of the planet’s
most deadly agents. All eight samples from Penfold Park would
eventually test positive. Later, the team would also find H5N1 (H5
hemagglutinin N1 neuraminidase) in a gray heron that had died in
the park. Ellis came down to the lab himself to look over the samples
and concurred that what was going on at Penfold Park was an avian
flu outbreak among migratory birds. This was the first time that
H5N1 had been found in migratory birds. Ellis went back upstairs to
his office.
M A L I K P E I R I S WA S P U L L I N G H I S B L A C K B M W I N T O I T S PA R K I N G
space at his Pok Fu Lam apartment when his mobile phone chirped.
As soon as he heard what Trevor Ellis had to say, he knew that his
upcoming holiday in his native Kandy, Sri Lanka, was probably going
to be canceled. Peiris, fifty-three, switched off the ignition and sat in
the front seat for a moment, listening as Ellis ran down the tests he
had performed and the positive results he had obtained.
They hung up. Peiris went upstairs and sat on his leather living
room sofa, across from his stereo and a Balinese wood carving that
hung on the white wall. Compactly built and broad-shouldered,
Peiris was five foot nine but gave the impression of being taller—
something about his bearing, a vestige of his patrician upbringing in
C H I N A S Y N D R O M E ■ 33
Sri Lanka and his Oxford education. His brown hair was parted high
on his wide forehead and had in the last few years become tinged
with gray. He had a slight overbite and a pronounced jawline; as he
mulled his options, that overbite began to seem even more exagger­
ated. When working in his lab at the University of Hong Kong’s
microbiology department, he wore wire-frame glasses. His careful
gaze could seem almost predatory, whether he was appraising a stu­
dent answering an exam question or divining which virus was grow­
ing in a cell line. His voice was gravelly and still inflected by a child­
hood and years of graduate and professional work in England. There
was in this man, sitting on his sofa listening to his son in the next
room playing on his Xbox, great intelligence, perspicacity, and clev­
erness. But that same intelligence had also bred ambition and a
desire for professional recognition and esteem that had not yet been
fulfilled. Though he had trained as a virologist, he had come to the
influenza field quite late, in his forties, an age when most scientists
are already established in their fields. He was still a relative new­
comer and was eager for an opportunity to do research and publish
substantial reputation-making work. What was happening out in
Penfold Park among migratory birds, Peiris well knew, could be that
chance. Disease outbreaks, Peiris sometimes thought, are what hap­
pen to lucky virologists when they are making other plans.
CHAPTER 5
■ December 20, 2002
■ Shenzhen, China
■ 28 Infected, 7 Dead
T H E D O W N S I D E O F T H E L A R G E S T M A S S U R B A N I Z AT I O N I N T H E H I S T O R Y
of the world soon began to appear. That many organisms the size of
human beings don’t migrate without creating a huge impact on their
environment and on other species. In this case, the effect was felt
not just by China’s already beleaguered wild animals but also by the
tiniest of organisms: the microbes.
In cities, we die in greater numbers and from more varied causes
than we ever did as nomads or villagers. History’s great urbanizations
have catalyzed epidemics of emerging or reemerging diseases. The
great Roman cities were ravaged by smallpox; the rich cultural flower­
ings of the Renaissance were also budding centers of plague; the com­
mercial centers of England’s industrial revolution were also bazaars for
the swapping of cholera and tuberculosis bacilli; North America’s turnof-the-century immigrant hubs were nexuses of typhoid, tuberculosis,
and, later, poliomyelitis; Africa’s late-twentieth-century urbanizations
may have been the catalyzing factor that launched HIV as a global epi­
demic. Every wave of migrants drawn by the big city has been accom­
panied on its journey by the Fourth Horseman. Indeed, it wasn’t until
the modern era that urban populations became self-sustaining; until
the eighteenth century, cities relied on rural migrants to replenish pop­
ulations culled by infectious disease.
The literature of the city is rife with decay and disease. Dickens,
Zola, Céline, Camus, Sinclair—each has described the metropolis as
C H I N A S Y N D R O M E ■ 35
a warren of corruption, filth, despair, and pestilence. Maybe there is
some primordial common sense in the puritanical sermonizing
against the vileness and wickedness of the city. For these places are
where man has taken perhaps his greatest and most precipitous falls,
not of a moral nature but a mortal one. While nomads were not free
of infections, their most common diseases were chronic instead of
acute. Deadly epidemics were limited and infrequent; there simply
wasn’t the population density required to sustain, say, a measles out­
break. Also, travel was sufficiently limited so that if a band or village
was stricken by a nasty outbreak, the outbreak was likely to stay local.
Most bacterial and viral infections left survivors immune, which
meant that a small population would quickly develop herd immunity,
preventing diseases from becoming endemic.
Once settlements pass a certain population threshold, say, several
thousand, they can, and do, support most modern-day zymotics, or
crowd diseases. When that happened first, probably in ancient
Mesopotamia, man’s history became the history of our diseases. For a
microbe, a city is a target-rich environment, with slabs of human meat
stacked literally one over another in apartments and houses, waiting to
be consumed. If there is any conceivable way for a microbe to move
from one species to another, it will find it. Of the four major modes of
disease transmission—waterborne, vector borne, airborne, or direct
contact—each is facilitated by urban life. Bacteria and viruses thrive in
the accumulated human and animal waste. Carriers of diseases are
attracted by the huge amounts of stored foods. Dirt and refuse draw
germ-bearing scavengers. Puddles and cisterns harbor mosquito larvae
carrying malaria, yellow fever, encephalitis, and dengue. Cats spread
toxoplasmosis. Rats carry plague.
It is modern science, medical care, and the better nutrition made
possible by advances in agriculture and animal husbandry that allow
humans to live relatively disease-free in cities. Remove any leg of this
tripod, and our happy hamlets might revert back into the dens of
pestilence they were throughout most of recorded history.
■ ■ ■
36 ■ K A R L T A R O G R E E N F E L D
C H I N A’ S G R E AT E C O N O M I C R E F O R M S M AY H A V E D O N E J U S T T H AT. AT
the precise moment when cities are being inundated with waves of
migrants that are straining infrastructure and resources—a hundred
thousand residents in Shenzhen, for example, don’t have potable run­
ning water—the health care system is in a state of virtual collapse. In
the past, rural Chinese could count on a few basic medical services,
usually provided by the armies of so-called barefoot doctors who
tromped through the countryside providing rudimentary care, setting
broken bones, giving prenatal exams, and vaccinating children. This
service, essentially free, helped to eradicate smallpox and sexually trans­
mitted diseases from China and partially accounted for the near dou­
bling of the country’s life expectancy, from thirty-five to nearly seventy,
between 1949 and 1990. That system, however, has been drastically
scaled back as health care in China has been privatized as rapidly as the
country has industrialized. Today, only 13 percent of Chinese have
health insurance. For the uninsured in China, just like their counter­
parts in America, this system has meant the end of preventive care.
Regional public health officials, also encouraged to seek profits, have
similarly concluded that the return on equity from immunization drives
and outbreak-response networks is minimal.
Many infectious diseases that were nearly eradicated during the
sixties and seventies are rebounding in China. Tuberculosis and hep­
atitis B are now spreading largely unchecked, with more than 130
million hepatitis B sufferers. AIDS afflicts 1.5 million and has finally
been acknowledged as a national health care crisis. Asthma, due in
part to a worsening air pollution problem, is afflicting as many as one
in four children in the Pearl River Delta. In the cities, doctors are
seeing diseases they haven’t encountered in a generation. Mao Tse­
tung had once declared war against infectious diseases, in particular
schistosomiasis, deploying armies of pesticide-wielding workers to
eradicate the host snail species and offer free checkups to those liv­
ing in the Chang (Yangtze) River region. By the late eighties, partly
as a result of that campaign, there were only four hundred thousand
cases left in China. Today, there are more than one million, and the
geographical range of the disease is again widening. Shenzhen’s
C H I N A S Y N D R O M E ■ 37
CDC (no connection to the U.S. Centers for Disease Control and
Prevention based in Atlanta) director, Zhuang Zhixiong, reports that
he has had to contend with schistosomiasis outbreaks during the
rainy season. This snail-borne blood fluke was brought into town by
migrant workers and apparently found conditions welcoming enough
to sustain its life cycle in some of Shenzhen’s flooded alleyways.
Recently throughout the Pearl River Delta, there have been measles
epidemics, meningitis outbreaks, and waves of dengue fever, malaria,
and encephalitis. “If it weren’t for improved nutrition,” says Julie Hall,
coordinator of communicable disease surveillance at the World Health
Organization in Beijing, “you would be seeing even more cases.”
William McNeill, in his classic book on the history of disease, Plagues
and Peoples, estimates that measles needs a population of at least seven
thousand susceptible individuals in order to maintain a chain of infec­
tion. Migrant Shenzhen neighborhoods such as Buji, Laohu, and the
Click could provide many more receptive immune systems than that.
Public health officials stress that it is virtually impossible to eradicate
these diseases because there are so many unvaccinated migrants arriv­
ing every day, providing a perpetual supply of meat for the measles
virus. Also, in migrant communities where roommates sometimes don’t
even know one another’s names, it is very hard to trace a disease out­
break back to try to find who might have been exposed, so that they can
be vaccinated or quarantined. “We basically just have to let these out­
breaks burn themselves out,” says Zhuang of the Shenzhen CDC.
Most migrants such as Fang Lin, of course, are even more terrified
of visiting a hospital than of coming down with a disease. One night in
a hospital bed could cost half a month’s wages, and that’s before any
intravenous drips or medications or expensive tests, which many
patients suspect doctors and nurses are overeager to administer and
perform in order to squeeze out a few more kwai. Instead, when you
fall ill, you drop in to one of the doctors’ offices that line the alleyways
of the Click, open up, say aah, and buy a box of pills. If you’re really
sick, you hand over a few more kwai, and the formerly barefoot doctor,
who now has shoes but the same narrow range of treatment options,
jabs a needleful of antibiotics into your ass. A report given by the
38 ■ K A R L T A R O G R E E N F E L D
Chinese government to the WHO in October 2003 conceded the prob­
lem: “At present, health development in China lags behind economic
development. The public health system is defective, the public health
emergency response system is unsound and the crisis management
capacity is weak.”
I F T H E R E WA S A S O U N D T R A C K T O T H E E R A O F W I L D F L AV O R , I T WA S
bleating, high-energy techno music. The steady, rhythmic, relentlessly
chirpy and upbeat dance tracks poured from every karaoke bar and fit­
ness club and pulsated from barbershop CD players and taxicab radios.
Grannies playing mah-jongg in the back of noodle shops had it cranked
up to ten; old men smoking Coco Palm cigarettes in front of their
knockoff-handbag stores had it blaring. During that season, the music
was inescapable, an aural pink champagne bath that immersed you as
soon as you crossed the border into Shenzhen. The synthetic high
energy of the music was sickly sweet. If it had been food, it would have
been cotton candy. If it had been a car, it would have been a cherry red
Miata. Sonically tawdry yet crudely infectious, the music kept you mov­
ing, a current that propelled you forward.
Shop owners, disco touts, cabdrivers—no one seemed to know the
names of any of the songs or acts. They would nod blankly when I asked
which artist was playing through their Skyfox speakers. The CDs were
often pirated copies of white-label releases. In other words, someone
had ripped off someone who had sampled someone else. The propri­
etresses of the knockoff-CD stores would direct me to racks of compi­
lations, long rows of jewel-box cases with Chinese writing proclaiming,
“Feel Good Music!” “Dance Forever!” “Wild Flavor Mix!” I recognized
a few of the acts: Vampire X and Shanghai Moon were two Chinese
dance-music collectives that were both derivative and, in their tireless
vacuousness, frighteningly appropriate. The sound was like the amyl
nitrate–driven house music from some long-ago season in Ibiza or
Benidorm, vaguely reminiscent of the Summer of Love, then chopped
up, dipped in sugar, and injected with steroids. Here, on these narrow
streets and in these muddy alleys and filthy shops, while you were step­
C H I N A S Y N D R O M E ■ 39
ping over this legless man or skirting that woman picking rice from a
garbage can, there was something disconcerting about this much
enforced feelgoodness. It felt as if the whole country were being pre­
pared for a mass aerobics workout.
The strange thing was, when I asked Fang Lin about the music, he
said he didn’t really notice it. The sound had become so familiar to him,
like the sound of jackhammering or drilling, that it no longer registered.
In the truck, on the way to pick up the wild animals and vegetables in
the markets, the driver (one of the Sichuanese brothers who ran the
joint) and Fang Lin found the music a steady distraction, which they
would listen to while they smoked their Honghe cigarettes. Back in the
chopping room, Fang Lin would sometimes cut according to the beat,
he said, but he never noticed when one song ended and another began.
The chefs, in between dishes, would stand beside their woks
smoking and slugging from screw-top jars of chuhai grain liquor.
In the summer, the temperature would climb to 110 degrees in
the kitchen and chopping room. The only good thing about the heat
was that it made most of the animals sluggish.
The restaurant went through one or two hundred animals a night.
High-volume creatures—wild rats, cats, and dogs—were stacked
near the kitchen. Fang Lin and his colleagues would organize the
animals so that the snakes—in season in late spring and summer—
and other animals that might take a bite out of you were under the
two fluorescent strip lights in the middle of the room. More docile
creatures, which posed less of a risk as they were extracted from
their cages, were kept in the corners, farther from the light. When an
order was called out, Fang Lin picked through the wooden and wiremesh cages until he found the beast he needed. There was a specific
technique for retrieving each animal. For a snake, one pinned the
head until the tail could be located, and that was used to swing the
animal over, smashing its head against the brick floor. A lizard had to
be thumped in the head with the fat part of a knife handle. Cats were
easy: reach in wearing the thick rubber gloves, pull the cat out, and
chop the head off; it usually took one clean blow with the cleaver.
The female civets were easily enough extracted and decapitated. But
40 ■ K A R L T A R O G R E E N F E L D
the males could put up a fight and might require the pronged stick,
which one chop boy would use to pin the animal to the back of the
cage while another bound its legs with duct tape. Then the animal
could be pulled out, killed, skinned, and made ready for the hot pot.
As the night went on and the calls came from the kitchen—duck,
duck, goose, pangolin, civet—the boys pulled the animals from their
cages, cut them, skinned them, bled them, separated the organs into
those that were prized for their various invigorating properties and
those deemed inedible or inauspicious, and then quartered the animals
so that they were ready to be cooked. The chefs would further slice the
animals according to the dish on order and their own recipes. Some
dishes, such as civet and snake, tended to be heavily seasoned, while
rat, for example, was usually skinned, basted in sweetened soy sauce,
grilled, and then chopped up like an order of barbecued pork.
Occasionally, an animal—a badger or, in one particularly frightening
encounter, a wild boar—would get loose before the coup de grâce was
administered, and the three chop boys would have to chase the animal
through the chop room and kitchen and, in the case of that boar,
through the dining room of the restaurant itself.
By the end of the evening, the floor of this charnel house of
doomed animals would be slick with blood and entrails and feces and
urine. The panicked animals released all manner of foul excretions,
with their dying act most often being defecation. While Fang Lin
became used to the noises—the construction, the music, and even
the shrieks and screams of dying animals—he never became used to
the smell. He kept a cigarette lit constantly, clenched between his
lips so that the trails of smoke were always pouring into his nostrils
and obscuring some of the stench.
The chefs would come out late in the evening to sit on the back
steps with the chop boys. Among them were two men from Sichuan
who still expressed occasional disgust at what Guangdong people were
willing to eat. And there was another fellow who claimed to be from
Guangxi Zhuang but who spoke with a perfect Beijing accent.
Whenever anyone asked him where in Guangxi he was from, he would
say, “The mountains.” Whenever anyone asked which mountains, he
C H I N A S Y N D R O M E ■ 41
would make a gesture that could be interpreted as meaning either
“very far away” or “leave me alone.” One evening he was gone, and the
two Sichuan chefs explained that he had stabbed another fellow in the
thigh after seeing him in the street. That man, like him, claimed to be
from Guangxi but spoke with a Beijing accent. The chop boys never
saw that chef again. It was no great loss, as the fellow hadn’t been a very
good chef, and though he had claimed to be familiar with the prepara­
tion of Wild Flavor, he seemed to have made up some of his recipes as
he went along, relying on soy sauce, ginger, and garlic instead of listen­
ing to the proprietress’s recommendations.
That chef was replaced by a fellow named Chou Pei, who came
from Heyuan and had been living in Shenzhen for over a year. He
was a quiet fellow, about five foot seven, with a fleshy face and spiky
black hair. Since he had come from a rural part of Guangdong, he
knew how to cook most of the dishes, and if there were any he wasn’t
sure about, he could call home to double-check or consult a card in
his pocket with the proprietress’s instructions.
One night, when several of the chefs and chop boys were sitting
around on the back steps, passing back and forth a jar of grain liquor,
Chou Pei looked at Fang Lin.
“You’ve got blood on your face,” he said.
Fang Lin reached up with his hand and rubbed his cheek.
“Other side,” Chou Pei pointed out.
Fang Lin tried the other cheek, and his hand came away coated
with blood. That entire side of his face, in fact, was covered with
some animal’s spilled guts.
He shrugged and wiped the blood and guts off with his T-shirt.
“It’s still there,” said Chou Pei.
“What?” Fang Lin asked.
“The blood.”
Fang Lin shrugged and wiped it again, this time smearing some of it
into his eyes. This wasn’t the first time the chop boys had gotten animal
blood in their eyes or noses or down their throats. But what did it mat­
ter? Who had ever been harmed by the blood of a few wild animals?
CHAPTER 6
■ December 25, 2002
■ Ah Chau Island, Starling Inlet, Hong Kong, China
■ 35 Infected, 8 Dead
ON CHRISTMAS MORNING, MALIK PEIRIS AND FELLOW UNIVERSITY OF
Hong Kong virologists Guan Yi and Zheng Bo Jian rode in Peiris’s
black BMW up Motorway 1 to Nam Chung Temple, in Hong Kong’s
New Territories, just a few miles south of the Chinese border. Peiris
parked in the gravel lot next to the temple, and the three men
stepped out of the car, unloaded their duffel bags from the trunk,
and slipped on their parkas, rubber boots, and gloves. At 7:00 A.M.,
the air was chilly, and as they walked past the temple with its three
red lintel altars and the offerings of oranges and incense laid out
before a statue of Confucius, they zipped up their jackets against the
damp breeze blowing from the Starling Inlet. Across the marshy
pond was Ah Chau, the small island that also served as a bird sanctu­
ary for several of Hong Kong’s migratory species. The island rose in a
gentle mound, with spruce, rain, and eucalyptus trees shooting leaf­
less branches skyward above the canopy. Vultures sometimes sat on
these highest branches. Below them, presumably, would be either
nesting egrets, cranes, and cormorants or hundreds of dead birds.
The rumors out of China were even more alarming than usual.
For example, during a November influenza conference in Beijing
attended by World Health Organization officials, Chinese clinicians
from Guangdong spoke darkly of an influenza outbreak that was
burning through rural hospitals. “They told us they were currently
having a severe influenza outbreak,” Klaus Stöhr of the World
C H I N A S Y N D R O M E ■ 43
Health Organization’s Global Influenza Programme had told Peiris
and Guan Yi. “Guangdong officials said, ‘People are dying like flies.’”
Stöhr followed up, requesting samples of the influenza strain in
question. What the Guangdong Health Department claimed to have
isolated was a standard A-type influenza, which was unlikely to have
caused the severe disease that clinicians had described.
When Stöhr inquired further, via the WHO’s Beijing office, he
was given a curt reply: “Everything is calm.”
Though no one in China had yet linked the unexplained deaths in
hospitals throughout Guangdong and postulated an epidemic, Hong
Kong health care workers, through their own informal contacts, were
already hearing anecdotal reports of an unexplained respiratory ail­
ment that had their mainland counterparts worried. Joseph Sung,
chief of gastroenterology and hepatology at Prince of Wales
Hospital, was scheduled to attend a conference in Guangzhou the
next week but was told by a physician at the Guangzhou Institute of
Respiratory Diseases, “Don’t come.”
When he asked why, he was told, “Something bad is going on
here. Just don’t come.”
What was it? Most of those medical professionals and public health
officials who were watching were wary of an influenza outbreak, and
when avian flu turned up in Penfold Park, that caused another round of
dark conjecture. As anecdotal reports of unexplained respiratory ail­
ments filtered back across the border, influenza experts around the
world perked up, and local virologists like Malik Peiris and Guan Yi
began to suspect that an influenza outbreak might be afoot. K. Y. Yuen,
the head of the University of Hong Kong microbiology department,
would discuss the matter with Margaret Chan, Hong Kong’s director
of health, and both believed there was a good probability that what was
going on in Guangdong was the flu. If it was avian influenza, they both
knew, then this would quickly become Hong Kong’s problem. So far,
however, there had been no instances of mass chicken infection—so
far. Winter in China is notorious for bringing on a host of respiratory
ailments, ranging from the common cold to asthma to influenza. When
you are traveling through Chinese cities in the weeks before the lunar
44 ■ K A R L T A R O G R E E N F E L D
New Year, it seems the whole population has a dry, hacking cough. It
was entirely possible that these tales of a deadly pneumonia were fan­
ciful, the medical equivalent of “Here There Be Dragons” scrawled at
the edge of medieval maps.
Medically speaking, China was, in many ways, outside the known
world. Good intelligence about what was going on in terms of infec­
tious disease was always hard to come by, to a great extent because
officials in Beijing were often themselves unaware of outbreaks in
the provinces. For Hong Kong’s public health team, there was noth­
ing else to do but keep the influenza surveillance network on alert—
and try to reach a Beijing Ministry of Health official who would tell
them what was really going on.
For Malik Peiris, Guan Yi, and the rest of the virologists and
researchers at the University of Hong Kong, the rumors of influenza in
China fueled their already considerable suspicions that China was a
hotbed of animal influenzas that periodically infected humans. The
Chinese government steadfastly maintained a position that China did
not have any avian influenza and forbade any virologists from collecting
samples to be tested outside China.
Peiris and Guan Yi would have to collect their own samples, first
from migratory birds—in the hopes of forestalling the later gathering
of samples from sick humans. Ag and Fish had arranged for a small
rowboat to be moored by the temple, and as the three men crossed the
mudflats to the boat, the mudskippers and crabs feasting on algae skit­
tered away. Offshore, where there would usually be a crane or two
picking its way gingerly with backward-bending knees through the
shallows, there was only still water. The team tossed their duffels into
the boat before casting off and scrambling aboard. Zheng, as the junior
scientist, was delegated the task of rowing as the two other scientists
prepared their sample containers and wooden swabs. They were here
to check ou